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Journal of Couple &

Relationship Therapy:
Innovations in Clinical and
Educational Interventions
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Supporting Transgender and

Sex Reassignment Issues
Gianna E. Israel
Published online: 22 Sep 2008.

To cite this article: Gianna E. Israel (2004) Supporting Transgender and Sex
Reassignment Issues, Journal of Couple & Relationship Therapy: Innovations in Clinical
and Educational Interventions, 3:2-3, 53-63, DOI: 10.1300/J398v03n02_06

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 Supporting Transgender
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and Sex Reassignment Issues:

Couple and Family Dynamics
Gianna E. Israel

SUMMARY. For the care provider unfamiliar with supporting transsex-

ual and transgender persons, as well as their partners, it becomes an im-
perative to be able to identify this population’s unique needs, transition
concerns and relationship dynamics. New challenges arise as transgender
clients become more prevalent within the GLBT community and contact
community clinical resources. These include distinguishing between
sexual orientation and the complexities of gender identity; differentiat-
ing actual transgender issues and ordinary relationship concerns; and
recognizing characteristics of strong relationships versus those doomed
to fail when one or both partner’s needs can no longer get met.
This article reviews an abundance of stereotypes adversely affecting
transgender individuals, relationships and which can taint the treatment

Gianna E. Israel is a Gender-Specialized Community Counselor and author. Ms. Is-

rael has provided nationwide telephone consultation, individual and relationship coun-
seling, and gender specialized evaluations and recommendations since 1988. She is
principal book author of Transgender Care with Donald Tarver, M.D. (Temple Uni-
versity Press/1997). She is a current HBIGDA member and former founding AEGIS
board member.
Address correspondence to: Gianna E. Israel, P.O. Box 424447, San Francisco, CA
94142. (E-mail at Gianna@counselsuite.com). Contact by phone: (415) 558-8058. Her
library is at (http://www.counselsuite.com).
[Haworth co-indexing entry note]: “Supporting Transgender and Sex Reassignment Issues: Couple and
Family Dynamics.” Israel, Gianna E. Co-published simultaneously in Journal of Couple & Relationship
Therapy (The Haworth Press) Vol. 3, No. 2/3, 2004, pp. 53-63; and: Relationship Therapy with Same-Sex
Couples (ed: Jerry J. Bigner, and Joseph L. Wetchler) The Haworth Press, Inc., 2004, pp. 53-63. Single or
multiple copies of this article are available for a fee from The Haworth Document Delivery Service
[1-800-HAWORTH, 9:00 a.m. - 5:00 p.m. (EST). E-mail address: docdelivery@haworthpress.com].

 2004 by The Haworth Press, Inc. All rights reserved.

http://www.haworthpress.com/web/JCRT
Digital Object Identifier: 10.1300/J398v03n02_06 53
 54 RELATIONSHIP THERAPY WITH SAME-SEX COUPLES

environment. At a core level, there exists the need for care providers to
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recognize when having a transgender identity stops being a disorder,

such as when the client is no longer gender dysphoric, and where the
care provider needs to advocate the individual’s right of self-determina-
tion. This includes recognizing when situational depression or anxiety
and social discrimination are the actual root of ongoing individual and
relationship concerns. With basic transgender knowledge, effectively
supporting transgender persons and their relationships is possible for
cross-specialty providers, and is recommended. [Article copies available
for a fee from The Haworth Document Delivery Service: 1-800-HAWORTH.
E-mail address: <docdelivery@haworthpress.com> Website: <http://www.Haworth
Press.com> © 2004 by The Haworth Press, Inc. All rights reserved.]

KEYWORDS. Transsexual, transgender, gender, couples, relationship,

dysphoria

Imagine for a moment if you can, the profound confusion and distress an in-
dividual might experience looking into a mirror and seeing an opposite-
gendered person staring back. Consider also not being able to determine
whether one is a gay male or straight female, or perhaps, a lesbian woman or
straight man! The preceding characterizes the discomfort which can arise for
transsexual and other transgender persons dealing with gender dysphoria
(Brown & Rounsley, 1996). It is one among many issues transgender people
and their partners must contend with.
For counselors and therapists who provide services to same sex couples,
transgender issues are becoming required knowledge as transfolk take on
more pronounced visibility and interaction with the GLBT communities. With
this development careproviders are asking questions. Possibly the most imme-
diate concern clinicians have is differentiating between various transgender
populations.
How is the professional supposed to define where a client is in transition,
support that process, and still take into account a broadening array of trans-
gender identities? Common sense would indicate that left unanswered such a
clinical dilemma points to the reason that transgender men and women are so
frequently turned away by providers. To determine what is going on with the
client one simply needs ask. Spend time helping the client focus and share a
personal and basic gender history. Then, look for patterns of consistency in the
past and the present. It would also be helpful to ask what name and pronouns
that person prefers. The longer an individual uses a “preferred” name, at least
 Clinical Issues with Same-Sex Couples 55

within discreet relationships, the more firmly grounded is the evolving gender
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identity.
Once it has been ruled out that the transgender client is not suffering from
psychosis or another thought-impairing malady, it becomes possible to con-
sider what issues the individual is presently experiencing and which are most
affecting a couple’s relationship (Israel & Tarver, 1997). If the person’s main
focus is to live “in role” at least part time and has chosen a preferred name, he
or she may be either a transsexual or transgenderist (Israel, 1996). In other
words, surgery is not an important issue at present, but developing a signifi-
cant cross gender role and public presentation definitely is. If the transgender
person expresses a consistent intention to undergo Genital Reassignment Sur-
gery, and has a well-developed plan for it, that individual is likely a transsex-
ual. It is these persons who fall under the larger transgender umbrella. Based
on my clinical experience, it is these persons who are also most likely to make
it into the office of a same sex counselor. These clients may emerge from ei-
ther gay or straight communities.
A person’s community of origin prior to coming to terms with gender issues
can play an important role in how both the couple and transgender individual
deal with relationship issues. For instance, heterosexual crossdressers are the
least likely to seek individual or couple counseling. When they do, a strong
emphasis on heterosexuality and short term work prevails with a focus on vali-
dation and cohesiveness (Miller, 1996). On the other hand, persons whose ori-
gin is the gay/lesbian community will be more cognizant of minority issues.
They are generally more self-aware and more likely to address a broader spec-
trum of issues in counseling.
In review, we have covered those persons that definitely believe they want
surgery, transsexuals; those individuals that definitely want to live in role part
or full time, transsexuals and transgenderists; and crossdressers who dress for
erotic satisfaction or social activities but don’t care to live “in role” or alter
their bodies. This essentially covers basic transgender populations. Other per-
sons who self-identify as transgender will have similar needs. It also should be
remembered that the label transgender is a sociopolitical construct–not a diag-
nosis. If the individual is gender dysphoric then Gender Identity Disorder is
the correct diagnosis. However, when dysphoria is resolved and the person
self identifies as transgender, it may be more appropriate to refer to whatever
mental health symptoms linger as the diagnosis. Insurance billing should be
discussed with the client, since not all individuals or couples are “out” to their
employer, and may not want gender-related diagnoses appearing on state-
ments (Israel & Tarver, 1997).
Before moving into a discussion of sexual orientation and how it may shift
for transitioning persons, a definition for gender identity is required. Gender
identity is not solely the masculinity or femininity a person feels on the inside,
it is also how one portrays this to the world and how others mirror it back to the
individual. This is critical knowledge for clinicians who come into contact
 56 RELATIONSHIP THERAPY WITH SAME-SEX COUPLES

with transgender persons. The heart of the gender conflict or dysphoria is that
the person is often desperate for respect of his or her self-identification includ-
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ing the gender identity component. Until individuals are able to find support
for their self-determined gender identity, there usually will be major social and
interpersonal conflict.
During evaluation if it becomes apparent that the gender identity of pre-
transition individuals is uncertain or immature, it often is and this is typically
the case for sexual orientation as well. The stronger a cross-gender identifica-
tion is, the more likely that individual will have to reassess and redefine his or
her sexual orientation if a transition is to be made. In a survey of clients in my
practice, approximately fifty-percent of persons who transition gender will re-
consider who they prefer for a sex partner. It is also not uncommon for two
transgender persons to be attracted, form a relationship, and benefit from each
other’s insights of a shared situation.

A RELATIONSHIP IN TURMOIL
Jan, a 43-year-old, male-to-female (MTF) pre-operative transsexual and
Evelyn a 48-year-old, genetic woman have been married for eleven
years. The couple sought couple counseling to help Evelyn better under-
stand Jan’s evolving gender identity.
Like many transsexuals, Jan had felt gender-conflicted since early
childhood. Jan’s first marriage was ended when her spouse found out
about her transsexualism. Consequently Jan told Evelyn that she had
these feelings at the onset of their relationship. For a number of years the
couple had lived together as man and wife, and Evelyn secretly hoped
the marriage would prevent Jan from transitioning. But, as is often the
case, having a “normal” relationship was not sufficient to deter Jan from
eventually coming to terms with her transsexualism.
Jan is now living full-time as a woman. Does that make her and
Evelyn a lesbian couple? Jan also had uncertainties about undergoing
genital reassignment because she feared major surgery. Conflicted, she
also wasn’t sure if she was attracted to men or women as a newly identi-
fied woman. Additionally, shortly after starting hormone therapy, she
and Evelyn stopped having sexual intercourse. Though this couple is in-
timate, in the sense of heavy petting and kissing, both wondered if they
would be able to sexually satisfy each other since hormones had dimin-
ished Jan’s sex drive.
Several foundations exist which are critical to providing basic support to
couples in which one partner has a transgender identity. These include encour-
aging clients to self-define their own gender identity and sexual orientation
even if those definitions contradict social norms (Cromwell, 1999). It is also
important to preserve the original caring which made their relationship de-
 Clinical Issues with Same-Sex Couples 57

velop. Finally, it behooves partners to learn as much as they can about trans-
gender issues before making any significant plans or changes.
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Before we can consider relationships which endure, an overview of reasons

why such relationships fail is required knowledge. The actions that most radi-
cally destabilize relationships are the transgender partner’s coming-out privately
and publicly; starting hormones; and preparing for and undergoing various ex-
pensive cosmetic and genital reassignment surgical procedures. This is true
whether a partner decides to live part-time in role, or permanently. Because
pursuing a well-planned transition takes months, this actually gives the couple
considerable opportunity to develop plans for safeguarding each other’s wel-
fare. If both parties are wise enough to fully exploit this window of opportu-
nity both can benefit.
The most destructive blow occurs when a spouse, stereotypically a hetero-
sexual woman, reactively abandons the relationship or evicts the transgender-
identified partner from the family home. This overreaction is traumatizing for
all parties involved, spouses and children (Brown & Rounsley, 1996). Dra-
matic endings are less common for heterosexual males. Those men with a
newly identified female-to-male (FTM) partner tend to move more slowly in
the task of termination and rebuilding their lives. In situations where a couple
is originally gay or lesbian identified, both tend to move in a more circumspect
fashion and often remain close friends and allies. The commonest dynamics
which characterize the non-transgender partner’s response follow.
“Denial” is a word that speaks volumes. Unlike those who terminate a rela-
tionship immediately, there are also spouses who don’t even want to deal with
the gender issue.
Some are likely to pretend nothing will change for as long as possible. Ini-
tially this works well, allowing a transitioning person to complete electrolysis
and build skills in his or her new role. But, long-term denial doesn’t allow the
non-transgender partner to prepare for his or her future. Often the non-trans-
gender partner will engage in passive-aggressive behavior and manipulation.
Up until the present, this article has dealt with examples in which most rela-
tionships will end or develop termination plans. Generally this occurs soon af-
ter discovery that a partner is transgender or discloses an intention to transition.
But, termination does not always have to be the end result. In some instances
couples stay together for years and exemplify great relationship skills, cohe-
siveness and deep caring. There are also persons emerging from gay or lesbian
relationships, who are not interested in transition or surgeries, but instead ex-
pect to be accepted as a “new man” or “new woman.” This trend demands fur-
ther inquiry as such couples become increasingly evident. Whatever a person’s
gender identification and sexual orientation, however, the best that care pro-
viders can do is facilitate the individuals’ meeting each other’s needs or ex-
plore moving on in a measured fashion.
While coming to terms with the gender issue, many partners will feel deeply
betrayed. This most often occurs when the transgender person did not have the
 58 RELATIONSHIP THERAPY WITH SAME-SEX COUPLES

communication skills to disclose earlier in the relationship. Sometimes it takes

years for the transgender person to learn how to tell another person about his or
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her gender dysphoria (Cromwell, 1999). Whereas the issue of loss may take
months, even years, to process, a failure to disclose early exacerbates issues of
trust and guilt. This is true whether or not the relationship remains intact.
What may come as a surprise to some careproviders, but not to most sepa-
rating couples, gender issues are often not the only problem though it may be
the catalyst for termination (Brown & Rounsley, 1996). In a general sense
within relationships partners see what they want in each other. However, if the
relationship does not evolve and mature at some juncture the illusions shatter,
leaving behind communication impasses, domestic conflicts and intimacy dif-
ficulties.
During counseling it is not uncommon for individuals or couples to demand
a care provider’s projection about whether a relationship is doomed to fail. Has
intimacy died? Does more fighting occur? Or, is it possible to overcome core
problems and reestablish a fulfilling companionship? Much will depend on
whether the ability to fulfill each other’s needs and a strong investment in the
relationship exists. Care providers need to be mindful of these dynamics and
not yield to the temptation of predicting a relationship’s outcome. Instead,
they should teach clients to draw their own conclusions and make informed
decisions.
Nothing exemplifies a relationship’s character better than how a couple han-
dles issues involving children. Like gay and lesbian parents, transgender
mothers and fathers face enormous social hostilities based on stereotypes
(Cromwell, 1999). Often these can be introduced into the situation by the non-
transgender spouse. I have observed within my clinical practice that GLBT
persons are capable of being good parents. Many are great, actually. Regretta-
bly, this rarely is publicized with society at large, and for many non-trans-
gender parents, a partner’s transitioning will inspire an abundance of fear. For
instance, many of these fears are a result of never actually having met
transgender persons who are parents. Referring such couples to groups which
include transgender parents can be a helpful intervention (Israel & Tarver,
1997).
Sometimes, parents will have very basic questions. Does exposure to a
transgender parent or person mean that a child will become transgendered?
No. Do young children adjust to a parent changing gender? The majority can,
particularly in families where respecting differences in other people is a value.
Should a child call his or her parent by a certain name, title or pronoun? No.
Children will always see the father as their father, or the mother as their
mother. Only with maturity and social sophistication will they learn to use vo-
cabulary appropriate to the transgender parent’s presentation.
The vast majority of children adjust very well to having a transgender par-
ent. As long as children are reassured that the gender conflict is the parent’s is-
sue, and are taught how to deal with peer harassment, most children will be
 Clinical Issues with Same-Sex Couples 59

satisfied with basic, honest answers to their gender related questions. Other-
wise, as with most young persons, they will mature and develop interests or
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agendas of their own. Many of the parent’s issues are destined to become non-
issues to children.
In working with both individuals and couples, I strongly encourage the
transgender parent not to look to their children as a primary source of gender
validation. The transitioning person is responsible for gaining his or her vali-
dation from adult sources, such as adult friends, family and a support network
(Israel & Tarver, 1997). Children always should be allowed to develop accep-
tance on their own terms. In other words, simply because a young daughter en-
joys shopping for women’s clothes with an male-to-female (MTF) parent, that
young child still sees the individual as her father. It may be some years before
that changes, even though outwardly she may say otherwise to please the par-
ent.
In counseling, couples should also be reminded that children generally
come from the parents caring for each other. Again, we return to the concept
that both parents need to respect the caring which served as an original founda-
tion for their relationship. Children need to see how loving, mature people act
toward each other. When this doesn’t occur the likelihood significantly in-
creases that the child will reject one or both parents. It is common for children
of all ages to deal with issues of denial, fear and loss when a parent discloses
his or her gender issues. When healthy coping mechanisms are not promoted,
however, children are all the more likely to adopt the credo of their peers,
which is generally to reject anything that is different or frightening.
Moving ahead to a new focus, genital reassignment surgery is usually seen
as the end-stage of a person dealing with his or her transsexualism (Miller,
1996). Be forewarned, that it is not. Surgical candidates are expected to have
lived legally in-role full time for at least one year, as well as having undergone
hormone administration, cosmetic procedures and been occupied with em-
ployment, volunteer activities or school as a new man or woman. Transsexual
clients are often unaware of how critical socialization is in all stages of transi-
tion in order to be well-adjusted post-operatively. Persons interested in perti-
nent clinical reading on male-to-female (MTF) and female-to-male (FTM)
surgical procedures, experiences and protocols may do so in the Transgender
Care book (Israel/Tarver, MD–Temple University Press, 1997).
The impact of genital reassignment affects a couple’s relationship in many
ways. Beyond the financial expense which is sometimes born by both part-
ners, there is also a high emotional toll. When a couple remains together, or at
least maintains a friendship, the non-transgender partner often will be asked to
lend comfort during the surgical partner’s post-operative recovery. Many do
so willingly, bringing each closer together and giving additional meaning to
the transition experience (Brown & Rounsley, 1996). Nevertheless, dealing with
major surgery and recovery creates a great deal of anticipatory anxiety for
both.
 60 RELATIONSHIP THERAPY WITH SAME-SEX COUPLES

Post-operatively, if the couple is to be sexually intimate, it is necessary that

they redefine what is sexually satisfying for each of them. In many cases, re-
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ferring back to the evolving sexual orientation issue, the post-operative trans-
sexual will have a healthy desire to explore his or her new genitalia and sex
roles (Israel & Tarver, 1997). This may present conflicts in a monogamous re-
lationship or at a minimum introduce unfulfilled desires which can prove chal-
lenging.

REFUND REQUESTED!
Ivy, a 43-year-old, genetic woman, has had a continuous relationship for
17 years with Heather, a 39 year old, post-operative transsexual woman.
Ivy coaxed her partner into couple counseling, even though she sus-
pected Heather needed individual therapy. In session, both of the women
agreed they had been through a lot together and had much invested in
their relationship. For instance, Ivy had held Heather’s hand after her
partner underwent genital reassignment fifteen years ago. Since then the
couple had purchased a house and were established participants in the
local women’s community.
At issue for Ivy was Heather’s behavior during the past 18 mon-
ths. As a couple both were secure financially. However, Heather had lost
her job and refused to look for work. Additionally, she had completely
let her appearance deteriorate. In street terms she looked “tore up” in
fact, more and more like a man. This was so even though Heather
claimed to have no intention to reverting to a masculine role. Ivy felt
frustrated because she invested herself into a lesbian relationship only to
find herself with a woman that looked more male than female.
To add to the couple’s difficulties Heather was staying up all night,
which conflicted with Ivy’s schedule. Heather also frequently refused to
eat and was so moody it became nearly impossible for Ivy to talk to her
without an argument occurring.
The couple’s counselor in this scenario had never worked with a
lesbian couple in which one partner was a post-operative or “post-op”
transsexual. Was the surgery a mistake? Probably not. Did Heather need
to have her hormone levels checked through blood laboratory testing to
insure she was receiving the right medication? Yes. Of more concern,
was Heather afflicted with depression? Perhaps so.

Abandoning a transition or “reverting role” is a fairly common phenomena

among pre- and post-operative transsexuals and other transgender persons
when mental illness strikes. It can undermine a person’s efforts to build self
confidence and establish a stable gender identity. Reverting is also very con-
fusing to the loved ones, friends and careproviders who supported the person’s
transition.
As the preceding case scenario “Refund Requested” portrays, a close ex-
amination of actual symptoms will reveal underlying mental disorders. Is it
 Clinical Issues with Same-Sex Couples 61

possible to address mental illness early enough to prevent reversion and other
types of deterioration? Generally, yes. The wisest course in the preceding sce-
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nario is to direct the transgender partner into individual therapy and schedule a
blood laboratory/medication check-up, so that his or her comfort levels can be
increased regardless of whether lingering gender issues remain (Israel & Tar-
ver, 1997). The reality is the longer a person lives in role, and we refer to
“years” in most cases, the less likely a permanent reversion will occur. After
all, transgender persons aren’t the only ones who allow their circumstances
and appearances to deteriorate when suffering mental illness.
The preceding scenario also introduces an ethical issue relevant to provid-
ing transgender care. Should the counselor who sees the couple also see the
transgender person individually? In the best of circumstances, the answer is
no. Doing so may give a misleading impression that the therapist is an ally of
one of the clients. Therefore, it would be more effective to have one therapist
for the couple and an individual care provider to help the transgender client deal
with gender and mental health issues.
Unfortunately, many communities may have a paucity of gender special-
ists. Less cosmopolitan areas may have few if any clinicians willing to see
transgender clients. Also, the cost of having a counselor for each family mem-
ber may be prohibitive. What should be done in a situation where the specialist
or gender-supportive counselor is faced with multiple demands? Where there
is a dearth of local resources it is reasonable to determine where the providers
skills would meet the most critical needs. This could be either the individual
and/or couple, whichever is determined to be most at risk.
While no transgender person should ever do without mental health care,
many individuals are capable of managing large aspects of transition using na-
tionwide resources, support groups and friends. In a similar vein, it is also pos-
sible for a couple to reach mutually healthy decisions and grow while dealing
with gender issues. This is particularly so if the transgender person is ade-
quately educated and able to inform his or her partner of what lays ahead (Brown &
Rounsley, 1996).
Staying together can have a positive impact on a couple’s relationship. Dur-
ing transition and afterward growth is possible. A couple’s ability to commu-
nicate can improve as a result of dealing with complex gender issues. Many
partners will report that much self blame was experienced in their relationship
prior to transition, but that this eventually resolved as each confronted the
other’s vulnerability. It is also possible that one or both partners will become
more socially outgoing. Dealing with gender issues requires enormous cre-
ativity; consequently, partners find themselves relaxing overly rigid bound-
aries, expectations and stereotypes (Cromwell, 1999).
Dealing with gender identity issues through and after transition requires a
massive psychological effort for the transgender person to attain a semblance
of normalcy. This can also be true for the long-term partner of such a person.
This is a dynamic which should not be ignored. Instead the couple’s counselor
 62 RELATIONSHIP THERAPY WITH SAME-SEX COUPLES

should highlight it as one of the relationship’s strengths. There certainly are no

right or wrong answers for approaching transgender issues when a couple
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strives to make a relationship work. What hopefully becomes evident with their
efforts is a continuous, healthy relationship.

COMMON TRANSGENDER STEREOTYPES

Popular fallacies can create treatment impediments for any population, and
this includes transgender persons and their partners. Even the most seasoned
gender specialist must strive against falling prey to assumptions about a cli-
ent’s experiences or imposing judgments on what should be a self-determina-
tion process (Israel & Tarver, 1997). Each of the following stereotypes are
false and demystified below:
• Transgender (TG) people are commonly viewed as mentally ill. Once
gender dysphoria resolves, however, having a TG identity becomes a
matter of self-determination of gender identity, not an illness. There
must be a consistent effort on the part of care providers to depathologize
the transgender identity to clients, their partners and others.
• TG people are believed to know of their gender identity early in life, such
as in childhood. In actuality some individuals may not become aware of
it until mid- or late-life. There are also individuals who may spend large
portions of their lives unaware that information about transgender per-
sons or gender issues actually exist.
• It is assumed that TG people typically want to end their current relation-
ship once coming to terms with their identity has occurred. Many, how-
ever, would remain in their current pre-transition relationship if the
choice was up to them. Unfortunately, often this cannot occur because it
is not always possible for every couple to meet each others needs.
• TG people are permanently disowned by their entire family after coming
out. Actually, although some are disowned, the vast majority of TG per-
sons are capable of maintaining or rekindling relationships as well as
forming new ones. Exploring and understanding this process is critical to
the success of the transitioning person, including those individuals who
may temporarily lose family members. It may take some time, months or
even years, for others to adjust to the transgender person’s evolving
identity and needs.
• It is easy to predict how a TG person will dress and what type of occupa-
tion he or she will engage in. This is incorrect. Many varieties of self ex-
pression exist for TG people, as with members of any community. TG
persons are skilled and employed in all fields.
• TG persons are perceived to live unhappy, unfulfilled or amoral lives.
This is a mischaracterization that is extended to many marginalized and
subjugated populations. Even in the throes of gender dysphoria, it is pos-
 Clinical Issues with Same-Sex Couples 63

sible for TG persons to experience joy, maintain positive goals and pur-
sue a meaningful spiritual existence.
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• TG persons are believed to always be at risk of losing child custody and

visitation rights. In reality, by carefully presenting educational materials
in family court, many TG persons have been able to secure their parental
rights. Such an effort should be case managed by a gender specialist fa-
miliar with custody issues.

REFERENCES
Brown, M. & Rounsley, C. (1996). True selves: Understanding transsexualism. San
Francisco: Jossey-Bass.
Cromwell, J. (1999), Transmen and FTM’s: Identities, bodies, genders and sexualities.
Urbana and Chicago: University of Illinois Press.
Israel, G. (1996), De Transgenderist: Als zelfidentificatie het opneemt tegen T &
T–stereotypen. Transformatie Journal. (3-6) Amsterdam.(Transgenderists: When
Self Identification Challenges Transgender Stereotypes) English version at http://
www.firelily.com/gender/gianna/transgenderists.html
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